{"id":"https://openalex.org/W99439600","doi":null,"title":"Are patients who use a generalist physician healthier than those who seek specialty care directly?","display_name":"Are patients who use a generalist physician healthier than those who seek specialty care directly?","publication_year":2005,"publication_date":"2005-11-01","ids":{"openalex":"https://openalex.org/W99439600","mag":"99439600","pmid":"https://pubmed.ncbi.nlm.nih.gov/16273451"},"language":"en","primary_location":{"id":"pmid:16273451","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/16273451","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Family medicine","raw_type":"Journal Article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5008313489","display_name":"George C. Xakellis","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I84218800","display_name":"University of California, Davis","ror":"https://ror.org/05rrcem69","country_code":"US","type":"education","lineage":["https://openalex.org/I84218800"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"George C Xakellis","raw_affiliation_strings":["Department of Family and Community Medicine, University of California, Davis, USA. gxakelli@worldnet.att.net"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Family and Community Medicine, University of California, Davis, USA. gxakelli@worldnet.att.net","institution_ids":["https://openalex.org/I84218800"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5008313489"],"corresponding_institution_ids":["https://openalex.org/I84218800"],"apc_list":null,"apc_paid":null,"fwci":0.7607,"has_fulltext":false,"cited_by_count":15,"citation_normalized_percentile":{"value":0.81808177,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":88,"max":96},"biblio":{"volume":"37","issue":"10","first_page":"719","last_page":"26"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.41280001401901245,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.41280001401901245,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.3490999937057495,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12918","display_name":"Healthcare Systems and Technology","score":0.11180000007152557,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/access-to-physicians","display_name":"access to physicians","score":0.4320000112056732},{"id":"https://openalex.org/keywords/generalist-physicians","display_name":"generalist physicians","score":0.75},{"id":"https://openalex.org/keywords/specialist-care","display_name":"specialist care","score":0.7900000214576721},{"id":"https://openalex.org/keywords/medicare-beneficiaries","display_name":"Medicare beneficiaries","score":0.7630000114440918},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.8040000200271606},{"id":"https://openalex.org/keywords/health-status","display_name":"health status","score":0.9610000252723694},{"id":"https://openalex.org/keywords/chronic-disease-burden","display_name":"chronic disease burden","score":0.9430000185966492},{"id":"https://openalex.org/keywords/health-care-utilization","display_name":"health care utilization","score":0.5109999775886536},{"id":"https://openalex.org/keywords/socioeconomic-status","display_name":"socioeconomic status","score":0.6029999852180481},{"id":"https://openalex.org/keywords/urban-rural-differences","display_name":"urban-rural differences","score":0.871999979019165},{"id":"https://openalex.org/keywords/rural-health","display_name":"rural health","score":0.3840000033378601},{"id":"https://openalex.org/keywords/fee-for-service-medicare","display_name":"fee-for-service Medicare","score":0.578000009059906}],"concepts":[{"id":"https://openalex.org/C20387591","wikidata":"https://www.wikidata.org/wiki/Q930752","display_name":"Specialty","level":2,"score":0.7351043820381165},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7059335112571716},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.6474905014038086},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.6070399880409241},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.47331011295318604},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4730707108974457},{"id":"https://openalex.org/C45371612","wikidata":"https://www.wikidata.org/wiki/Q3058587","display_name":"Generalist and specialist species","level":3,"score":0.47204503417015076},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.46636614203453064},{"id":"https://openalex.org/C137403100","wikidata":"https://www.wikidata.org/wiki/Q41710","display_name":"Ethnic group","level":2,"score":0.46610650420188904},{"id":"https://openalex.org/C26869875","wikidata":"https://www.wikidata.org/wiki/Q2596417","display_name":"Beneficiary","level":2,"score":0.4581943452358246},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.4224920868873596},{"id":"https://openalex.org/C2780084366","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demographics","level":2,"score":0.4214992821216583},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.09069639444351196},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0},{"id":"https://openalex.org/C19165224","wikidata":"https://www.wikidata.org/wiki/Q23404","display_name":"Anthropology","level":1,"score":0.0},{"id":"https://openalex.org/C18903297","wikidata":"https://www.wikidata.org/wiki/Q7150","display_name":"Ecology","level":1,"score":0.0},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.0},{"id":"https://openalex.org/C185933670","wikidata":"https://www.wikidata.org/wiki/Q52105","display_name":"Habitat","level":2,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003430","descriptor_name":"Cross-Sectional Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005194","descriptor_name":"Family Practice","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006278","descriptor_name":"Medicare","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006304","descriptor_name":"Health Status","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008511","descriptor_name":"Medicine","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D010821","descriptor_name":"Physicians, Family","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D012424","descriptor_name":"Rural Population","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012959","descriptor_name":"Socioeconomic Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D013038","descriptor_name":"Specialization","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D014505","descriptor_name":"Urban Population","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016015","descriptor_name":"Logistic Models","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017281","descriptor_name":"Cost of Illness","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018588","descriptor_name":"Fee-for-Service Plans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"pmid:16273451","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/16273451","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Family medicine","raw_type":"Journal Article"},{"id":"mag:99439600","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/16273451","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":null,"is_accepted":false,"is_published":false,"raw_source_name":"PubMed","raw_type":null}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.8560000061988831,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"},{"score":0.7390999794006348,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":9,"referenced_works":["https://openalex.org/W1920953986","https://openalex.org/W1967237446","https://openalex.org/W2063056743","https://openalex.org/W2087816928","https://openalex.org/W2098810070","https://openalex.org/W2104199265","https://openalex.org/W2114600340","https://openalex.org/W2330455063","https://openalex.org/W2332830788"],"related_works":["https://openalex.org/W3015912994","https://openalex.org/W2131623311","https://openalex.org/W2398276376","https://openalex.org/W4249342133","https://openalex.org/W1845508465","https://openalex.org/W2335439606","https://openalex.org/W6976987653","https://openalex.org/W2114600340","https://openalex.org/W2937373511","https://openalex.org/W2168510418"],"abstract_inverted_index":{"BACKGROUND:":[0],"American":[1],"health":[2,28,42,103,182,204,239,301,308,339],"care":[3,302],"consumers":[4],"want":[5],"the":[6,39,112,129,189,224,237,242,282,292,306],"option":[7],"of":[8,26,44,53,75,106,149,171,203,246,259,285],"seeing":[9],"specialists":[10,198,317],"whenever":[11],"they":[12,19],"wish,":[13],"but":[14,335],"given":[15],"this":[16],"option,":[17],"do":[18],"in":[20,154,338],"fact":[21],"use":[22],"it":[23],"without":[24],"consideration":[25],"their":[27,319],"status?":[29],"This":[30],"paper":[31],"reports":[32],"on":[33],"a":[34,86,92,158,163,220,271,324,347],"cross-sectional":[35],"analysis":[36],"that":[37,209],"compares":[38],"demographics":[40],"and":[41,69,95,108,126,166,184,206,227,241,265,316,332],"status":[43,183,205,240,309,340],"fee-for-service":[45],"Medicare":[46,58],"enrollees":[47],"who":[48,84,90,97,174,193,218,232,322,345],"exhibited":[49],"four":[50,76,113,130],"different":[51,213],"patterns":[52],"physician":[54,81,153,177,235,260],"access.":[55],"METHODS:":[56],"The":[57],"Beneficiary":[59],"Survey":[60],"data":[61],"from":[62,214],"1998":[63],"were":[64,71,116,133,210,223,252,262,266,276,295,310],"used.":[65],"Subjects":[66,173,192,217,231,304,321],"ages":[67],"65":[68],"older":[70],"categorized":[72],"into":[73],"one":[74],"groups:":[77],"those":[78,83,89,96],"with":[79,278,305],"no":[80,152,234,336],"claim,":[82],"saw":[85,91,98,151,157,175,194,219,233],"generalist":[87,159,348],"only,":[88,94,160,165],"specialist":[93,164,221,272,286,325],"both.":[99],"Age,":[100],"income,":[101],"education,":[102,331],"status,":[104,121],"level":[105],"impairment,":[107],"disease":[109,207],"burden":[110,208],"for":[111,128,318],"patient":[114,131],"groups":[115,132],"compared":[117,134,342],"using":[118,135,140],"ANOVA.":[119],"Urban/rural":[120],"race,":[122],"ethnicity,":[123],"mortality":[124],"rates,":[125],"gender":[127],"chi-square.":[136],"A":[137],"predictive":[138],"model":[139],"mutinomial":[141],"logistic":[142],"regression":[143],"was":[144],"created.":[145],"RESULTS:":[146],"Twelve":[147],"percent":[148],"subjects":[150,294,344],"1998,":[155],"11.6%":[156],"14.2%":[161],"visited":[162,168,323,346],"62.1%":[167],"both":[169,176,314],"types":[170,178],"physicians.":[172],"had":[179,200,236,327],"significantly":[180,212],"worse":[181],"more":[185,253,267,330],"chronic":[186,244],"diseases":[187,245],"than":[188,261],"other":[190],"groups.":[191,249],"generalists":[195,315],"only":[196,199,222,287,326],"or":[197],"intermediate":[201],"levels":[202],"not":[211],"each":[215],"other.":[216],"most":[225],"affluent":[226],"highly":[228],"educated":[229],"group.":[230],"best":[238],"fewest":[243],"all":[247],"subject":[248],"Urban":[250],"residents":[251,264],"likely":[254,268,297,311],"to":[255,269,298,312,343],"visit":[256,299],"some":[257],"type":[258],"rural":[263],"see":[270],"only.":[273,349],"Regional":[274],"differences":[275],"noted,":[277],"New":[279],"England":[280],"showing":[281],"highest":[283],"rates":[284],"use.":[288],"DISCUSSION:":[289],"As":[290],"expected,":[291],"healthiest":[293],"least":[296],"any":[300],"provider.":[303],"worst":[307],"access":[313],"care.":[320],"higher":[328],"incomes,":[329],"urban":[333],"residence":[334],"difference":[337],"when":[341]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2024,"cited_by_count":2},{"year":2020,"cited_by_count":1},{"year":2018,"cited_by_count":1},{"year":2017,"cited_by_count":2},{"year":2016,"cited_by_count":1},{"year":2012,"cited_by_count":2}],"updated_date":"2026-11-10T11:39:43.021295","created_date":"2016-06-24T00:00:00"}
